Facial Paralysis - Facial Nerve Palsy

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Facial paralysis (facial paralysis)

Facial paralysis (facial paralysis) is weakness or paralysis of the facial muscles, which can usually affect one or more rarely both halves of the face. It is caused by damage to the facial nerve or the area of the brain that controls the facial muscles - often without an apparent cause. The symptoms can disappear over time, but can also persist permanently. The causes of facial paralysis are diverse and not yet fully explored. Depending on which area is affected, a distinction is made between a peripheral and a central form.

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What are the causes of facial paralysis?

The causes of facial paralysis are diverse and not yet fully explored. A distinction is made between the following forms:

Peripheral facial palsy

In peripheral facial paralysis, the disease is caused by damage to the nerve itself. Depending on the cause, a distinction is made between the so-called idiopathic facial palsy and the facial palsy caused by defined diseases.

Idiopathic facial palsy

In over 60 percent of the cases, no direct cause for the paralysis of the facial nerve (facial nerve, VIIth cranial nerve) can be demonstrated. It is believed that various factors lead to inflammatory edema of the nerve, which increases tissue pressure in the nerve as it travels through the bony nerve canal. This idiopathic facial palsy often disappears completely. It is by far the most common cranial nerve lesion. The figures vary between seven to 40 people affected per 100,000 inhabitants every year, with the frequency increasing with age. The risk of developing the disease may be increased during pregnancy.

Basic diseases that can trigger peripheral symptomatic facial palsy include:

• Infections: e.g. shingles of the ear (herpes zoster), borreliosis, measles, mumps, rubella, diphtheria, HIV, syphilis;
• Constrictions in the nerve canal: eg in the case of otitis media;
• Cancer diseases: eg tumors of the parotid gland, brain or cranial nerves as well as metastases in the brain;
• Diabetes : diabetes mellitus, especially in connection with high blood pressure;
• Autoimmune diseases: e.g. Sjogren's syndrome;
• Injuries: eg fractures of the skull base, jaw or temporal bone;
• Operations on the course of the facial nerves (partial cutting or stretching);
• Poisoning ( see Poisoning for more information ).

Central facial palsy

Central facial paralysis is the result of a functional disorder directly in the relevant brain area. Possible causes include:

• Stroke
• Cerebral hemorrhage,
• Inflammatory brain diseases (e.g. encephalitis, multiple sclerosis),
• Brain tumors.

What are the symptoms?

• In peripheral facial palsyThe following complaints occur, among others: The failure of the facial muscles leads to a reduced or absent lid closure of the eye on the affected side. The eye can dry out, which can lead to inflammation and ulcers. The corner of the mouth is lower, is open and cannot be pulled up or to the side. There is difficulty eating, drinking and speaking. The sense of taste, saliva and tear secretion can also be impaired. The forehead appears smooth and with few wrinkles. Most peripheral facial paralysis goes away within days to weeks, in rare cases it can last up to six months or longer. In the case of pronounced damage to the nerve (e.g. due to accidents) or severe underlying diseases (e.g. tumors,neurological diseases), permanent paralysis can occur.
• In the central facial palsy show include the following symptoms: It is a weakness of the mouth and cheek muscles, mouth and cheek hanging down. The forehead muscles, on the other hand, remain mobile and the eyelid closure is retained.

How is the diagnosis made?

First of all, the doctor collects the medical history in a conversation (anamnesis). Then the facial muscles, ears, eyes and tear production are checked and neurological and electrophysiological examinations are carried out. If necessary, further examinations follow, in particular:

• Laboratory tests: examinations of cerebral fluid and blood.
• imaging tests: ultrasound, MRI, or CT;

How is facial palsy treated?

The earlier treatment is given, the better the chances of recovery. Overall, the prognosis for the disease is good.

• If the cause can be identified, the facial nerve palsy is treated specifically - if possible - with antibiotics or surgery, for example. For shingles, virustatic therapy should be used.
• In the case of idiopathic facial nerve palsy, ie without an apparent cause, corticosteroids are primarily used.
• If the eyelid is not closed completely, the eye is kept moist with eye drops and / or a so-called watch glass bandage (at night) and the cornea is protected with eye ointment. Another possibility is the so-called lid loading. Lead plates are temporarily glued to the upper eyelid or gold or platinum weights are permanently inserted into the upper eyelid muscles.
• Warm face packs and gentle massages of the paralyzed muscles can have a beneficial and pain-relieving effect. In addition, careful oral hygiene is recommended to prevent food debris from remaining in the cheek pockets. If you are sensitive to light, wearing sunglasses is cheap.
• In the further course, physiotherapy and electrotherapy, biofeedback and special speech therapy exercises for the facial muscles are recommended.
• If the facial nerve palsy persists, plastic-reconstructive surgical interventions to restore nerve function can be considered in certain cases.
• Botulinum toxin injections may lead to an improvement in facial movement disorders that can occasionally occur after peripheral facial paralysis.

Whom can I ask?

If you experience paralysis or abnormal sensations in your face, you can contact the following offices:

• General Practitioner,
• Specialist in neurology,
• Specialist in ENT,
• Specialist in plastic surgery.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

• Right to treatment
• Visit to the doctor: costs and deductibles
• What does the hospital stay cost?
• Prescription fee: This is how drug costs are covered
• Medical aids & aids
• Health Professions AZ
• and via the online guide to reimbursement of social insurance costs.